Chest drain for MRCEM
anatomical landmarks: safe triangle
This triangle is formed by the anterior border of the latissimus dorsi, the lateral border of the pectoralis major muscle, (the area superior to a line horizontal to the level of the nipple) and the apex below the axilla.
right patient ?
INR <1.5 preferably
right injury?
- moderate or large pneumothorax
- haemothorax visible on CXR
- haemo/pneumothorax.
right time?
- does it need to be done in ED, or would it be safer in theatre (especially if further surgical interventions are planned and patient will be intubated and ventilated)
therapeutic aspiration
- stop when patient starts coughing or 1.5L withdrawn
removal of chest drain
- ↑ intra-thoracic pressure → inspiratory pause or ask patient to bear down